A 45-year-old man with a history of IV drug use presented to the emergency room complaining of a rash and fever

History and Physical Examination

A 45-year-old man with a history of IV drug use presented to the emergency room complaining of a rash and fever.The patient also complained of a several-day history of malaise, fatigue, headaches, and a sore throat.

Physical examination revealed a moderately ill-appearing man with a temperature of 38.8°C (102°F). He had a blanching erythematous, macular-papular rash evident over the trunk, back, and upper and lower extremities. In addition, his throat showed enlarged tonsils and broad-based ulcerations on the buccal mucosa.

He had a history of an episode of endocarditis 2 years ago. At that time, an HIV serology test was performed. It was negative.

Laboratory Data

A CBC and liver function tests were ordered. Results showed that the patient is anemic (hematocrit, 38%). He also had a severely decreased total leukocyte count and a severely decreased absolute lymphocyte count. Some of his liver function test results were abnormal.

Group Discussion Questions

1. What is a likely diagnosis of this patient’s condition?

2. What is the natural history of this disease ( stages of the disease) ?

3. What immunologic laboratory tests might be of value in establishing a diagnosis for this patient?